- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $314.89 / $405.12 / $518.52
| Professional | | $314.89 | $405.12 | $518.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $35.36 / $44.40 / $51.50
| Professional | 26 | $35.36 | $44.40 | $51.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $279.52 / $360.73 / $467.01
| Professional | TC | $279.52 | $360.73 | $467.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $920.39 / $1,031.31 / $1,062.58
| Professional | | $920.39 | $1,031.31 | $1,062.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $106.72 / $118.25 / $119.58
| Professional | 26 | $106.72 | $118.25 | $119.58 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $813.67 / $911.73 / $944.33
| Professional | TC | $813.67 | $911.73 | $944.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.53 / $512.53 / $640.66
| Professional | | $512.53 | $512.53 | $640.66 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $58.23 / $58.23 / $72.79
| Professional | 26 | $58.23 | $58.23 | $72.79 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $454.30 / $454.30 / $567.88
| Professional | TC | $454.30 | $454.30 | $567.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $540.48 / $995.71 / $2,779.34
| Professional | | $540.48 | $995.71 | $2,779.34 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $61.07 / $105.85 / $306.82
| Professional | 26 | $61.07 | $105.85 | $306.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $479.41 / $884.91 / $2,481.83
| Professional | TC | $479.41 | $884.91 | $2,481.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $459.41 / $969.82 / $1,086.50
| Professional | | $459.41 | $969.82 | $1,086.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $30.53 / $51.91 / $110.80
| Professional | 26 | $30.53 | $51.91 | $110.80 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $407.50 / $830.98 / $884.91
| Professional | TC | $407.50 | $830.98 | $884.91 |